Medicare Advantage Plans

[Dutch_12078]

My wife and I have been very pleased with our zero additional premium United Healthcare Advantage plans. We've both gotten treatment in MI and FL at the same co-pays we pay at our "home" area in upstate NY. When she was actively being treated for cancer, her NY primary oncologist worked cooperatively with her Florida oncologist to coordinate treatments while we were there for the winter. Our total annual health care costs have been significantly lower than the premiums would have been for the supplement plans.

[Blues]

4 hours ago, bigjim said:

 If I am correct my supplement will not let me re-enroll if I ever drop it although that may not be correct.

I find the whole Medicare scheme to be almost impenetrable, and can't find a reference on medicare.gov about this, but according to the AARP website:

Quote

If you dropped a Medigap [aka "supplement"] policy to join a Medicare Advantage plan, you can return to original Medicare and get your Medigap policy back on the same terms provided that this is the first Advantage plan you’re [sic] ever had and you’ve been in it for no longer than 12 months. (This first year in a Medicare Advantage plan counts as a trial period.)

It also says that some states are less restrictive on this and have different rules about "guaranteed issue" of supplemental policies, but in general, it looks like the system is designed to let someone try out an Advantage plan for a year with no risk of being refused acceptance into the supplemental plan he had before switching to the Advantage plan.

[Randyretired]

The number of people on Medicare Advantage plans is noth of 20,000,000 and my DW and I are among them.  Our plan is provided by my DW's former employer and covers us anywhere that accepts Medicare, so we can travel.  The additional benefits such as glasses and hearing aids save us money.  It is a great plan that is paid for by her former employer and has a maximum out of pocket of $150 a year.  Not all Advantage plans are the same and benefits and costs vary widely so it would pay to shop carefully.  As others have pointed out finding the best Medicare plan for each of us can be an adventure but worth it.

[ToddF]

My understanding is that the government pays the insurer a fee for each enrollee in the medicare advantage program. The players are HUGE insurance companies and they manage the participants care in an effort to reduce fraud, waste and unnecessary charges. Think of the company as your advocate with a dual mission...keep you healthy and keep costs low. Also, because of their size, they may negotiate favorable reimbursement rates with their providers when compared to other options, like paying cash for services.

As a tax preparer, I haven't paid much attention to the details of the different options over the years, but I have noticed huge variations in what people pay for supplemental insurance once they go on medicare. Many like "GOLD" coverage that pay for everything, but in addition to the $144 month for Part B, they often pay $200-$300 month for their plan.

For someone like me who works out at the gym, goes to a chiropractor, bikes every day etc, it makes more sense to go with the no premium option and save the money on the side so I can pay my chiropractor of choice out of pocket if necessary. If I have a heart attack or get cancer, Healthpartners has Regions Hospital in St Paul which I know to be an A+ provider as my Dad had major surgery there and the place is amazing.

[bigjim]

2 hours ago, ToddF said:

For someone like me who works out at the gym, goes to a chiropractor, bikes every day etcWi

with the covid situation are you still able to  utilize some of the benefits.  It seems like a lot of them promise benefits that may be only  availible in certain areas but sounds good to get you to make the switch.. What if most of their clients started utilizing the benefits  regularly. Would they be overwhelmed would the price go up substatially next year. I don't want to come across as untrusting of all their promises but I am untrusting of their promises.

[Randyretired]

23 minutes ago, bigjim said:

3 hours ago, ToddF said:

For someone like me who works out at the gym, goes to a chiropractor, bikes every day etcWi

with the covid situation are you still able to  utilize some of the benefits.  It seems like a lot of them promise benefits that may be only  availible in certain areas but sounds good to get you to make the switch.. What if most of their clients started utilizing the benefits  regularly. Would they be overwhelmed would the price go up substatially next year. I don't want to come across as untrusting of all their promises but I am untrusting of their promises.

Some of the insurance companies offering the Advantage plans have been doing this for 20 years or more.  In our case the benefits have actually improved over the years.  In many (maybe most) cases these are the same insurance companies offering the Supplement plans.  These companies have increased their Advantage plan offerings because these have been profitable to them and customers like them.  As I posted earlier there are over 20 million people on these plans and the number is growing year over year. The costs and benefits of these Advantage plans vary widely as many companies offer a number different plans within their portfolio.   Advantage plans are not just for the less fortunate among us as some suggested but just another choice that may be best for many.

[whj469]

We use an Advantage Plan this is local to the Houston, Texas area. It only covers emergency care out of that area. We chose it because it does not cost extra. We have used the provider for many years. They want about $600 per month for supplement insurance for both of us. That is $7,200 per year. With the Advantage Plan I got a new pacemaker for a total of $200. Some skin cancer cut off my chest for $200 and throat surgery for $200. The throat surgery was the fourth try and it worked. Also two months ago hernia surgery for $200 as well. That I can afford. They only issue is that we spend 4 months in the UP of MI every summer, so emergency care only. The only experience we have had with that was when a friend was in the UP with us and he had a heart attack with the same Advantage Plan as us and it covered all cost except $200. Including a transfer to a different hospital down state.

[Randyretired]

All Medicare Advantage Plans also have a maximum out of pocket each year.  Medicare dictates the maximum it can be but many plans are less than the maximum Medicare allows.  

[Dutch_12078]

2 hours ago, whj469 said:

We use an Advantage Plan this is local to the Houston, Texas area. It only covers emergency care out of that area. We chose it because it does not cost extra. We have used the provider for many years. They want about $600 per month for supplement insurance for both of us. That is $7,200 per year. With the Advantage Plan I got a new pacemaker for a total of $200. Some skin cancer cut off my chest for $200 and throat surgery for $200. The throat surgery was the fourth try and it worked. Also two months ago hernia surgery for $200 as well. That I can afford. They only issue is that we spend 4 months in the UP of MI every summer, so emergency care only. The only experience we have had with that was when a friend was in the UP with us and he had a heart attack with the same Advantage Plan as us and it covered all cost except $200. Including a transfer to a different hospital down state.

Our zero additional premium Advantage Plan from United Healthcare includes in plan coverage everywhere in the US that UHC covers. That typically just leaves out a few counties in some states. And urgent and emergency care is covered everywhere of course. There's also out of plan coverage at higher co-pays as well.

[whj469]

I was the CEO of a company before I retired in September 2016 and I have had lots of experience with United Healthcare. It has all been bad. One thing that they did for me was, because of their increases for health insurance, I took our plan for over 500 employees and self funded it and in two years saved more then $600,000. United Healthcare was almost impossible to deal with! The last time they bid on our health insurance they wanted a 10% increase and when I told them that we only spent 60% of our premiums on healthcare they responded yes but the ACA which we had been under for two years. I want nothing to do with United Healthcare. I am told that they are the largest healthcare insurer? You do need a healthcare expert to take a plan to self funded but it has worked well for the company that I was the CEO of.

[Randyretired]

 We had a Medicare supplement through United Health care they were very difficult to deal with and under paid on more than one occasion.  I fought with them over payments they didn't make or shorted by thousands of dollars.  If I was persistent enough they would finally pay.  However, we now have a Medicare Advantage Plan with UHC and it is like dealing with a different company.  They have been helpful and the only problems we have had has been with the hospital billing.  UHC has even helped us with that.

[Al F]

7 hours ago, Randyretired said:

 We had a Medicare supplement through United Health care they were very difficult to deal with and under paid on more than one occasion.  I fought with them over payments they didn't make or shorted by thousands of dollars.  If I was persistent enough they would finally pay.  However, we now have a Medicare Advantage Plan with UHC and it is like dealing with a different company.  They have been helpful and the only problems we have had has been with the hospital billing.  UHC has even helped us with that.

Which Medicare supplement did you have?  Also curious as to what UHC under paid. 

We have Plan F though USAA.  It primarily pays 20% copay that we would usually need to pay.  Seems pretty cut and dried as to what to pay, seeming to me to be hard to under pay.

[docj]

One issue that rarely gets mentioned in threads like this one is that some Medicare Supplements provide out-of-US emergency coverage ($50k).  I don't believe Medicare Advantage plans necessarily have such coverage.  It's not a huge benefit and it is on a reimbursable basis but we like to summer in Canada and this keeps us from having to purchase supplemental insurance.

IMHO the bottom line is that some people don't mind having "managed care" plans and some haven't had good experiences with them.  We've had a number of PPOs and an HMO during our working years and our experiences have varied. 

For the ~10 years we've been full-timing I've enjoyed not having to ask a doctor's office "do you take [specific insurance] plan?"  We haven't had a lot of emergencies while traveling, but we've had a couple plus a few more complex problems. I like not having to even think about "what will my out of pocket costs be?"

[Dutch_12078]

We've both had UHC's Medicare Advantage Plan for over 10 years and have never had a provider mention a payment issue to us. As far as I can tell, UHC has always paid the contracted rates that the providers agreed to.

[Randyretired]

1 hour ago, Al F said:

Which Medicare supplement did you have?  Also curious as to what UHC under paid. 

We have Plan F though USAA.  It primarily pays 20% copay that we would usually need to pay.  Seems pretty cut and dried as to what to pay, seeming to me to be hard to under pay.

We had a Medicare supplement plan through a former employer.  It was difficult for me to understand medical billing but my DW was having treatment at the Mayo clinic and she saw the same doctor billed under the same codes multiple times.  The billing amount was the same each time but the amount UHC paid was 3 different amounts.  Based on this I complained and after I pushed it some UHC assigned a person to go over all of UHC payments to MAYO with me.  She found numerous errors in the amount paid that amounted to several thousand dollars.  After she found these errors it had to go to a committee to be approved.  I don't remember how long that took but I believe it was 90 days for the committee and months for the review.  In the mean time Mayo was waiting to be paid.  I had to make monthly payments until UHC finally came through and I could get a refund.  The bills for this treatment were extensive and included a hospital stay.  Some of the Mayo bills were paid in full by Medicare such as the hospital stay.  Others Medicare only pays 80% then these bills were sent to UHC for their payment and we were left with a small amount to pay under this supplement.  I asked UHC for a list of what they should pay for each code billed but they never would give me that.  This is kinda of a complicated deal and Mayo's complicated billing practices made it worse.  Mayo would only have Medicare send payments that Medicare paid in full to them.  All of the Medicare payments that required additional funds from insurance were sent to us.  Mayo filled out the form for UHC and those funds were also sent to us.  We then had to pay these funds to Mayo.  Needless to say there were large sums of money going through our bank account.  Trying to keep all of this straight was crazy and nearly impossible but when the money required from us became excessive I started looking for problems.  I also needed surgery during this time and went to Mayo.  We found more UHC under payments for that.  So all of this was going on for both of us at the same time.  These UHC plans paid most of our bills and in the past when we only had minor bills and I would just pay what was billed.  I have to wonder if those bills were accurate?

The Medicare Advantage that we have now only requires a small $10 copay when seeing specialists all other medical bills are paid in full.  We have not had any problems with UHC with this plan and when the hospital makes an error and sends us a bill UHC has stepped in when requested to solve the problem.

Edited December 17, 2020 by Randyretired
Clarity

[Al F]

16 hours ago, Randyretired said:

We had a Medicare supplement plan through a former employer.  It was difficult for me to understand medical billing but my DW was having treatment at the Mayo clinic and she saw the same doctor billed under the same codes multiple times.  The billing amount was the same each time but the amount UHC paid was 3 different amounts.  Based on this I complained and after I pushed it some UHC assigned a person to go over all of UHC payments to MAYO with me.  She found numerous errors in the amount paid that amounted to several thousand dollars.  After she found these errors it had to go to a committee to be approved.  I don't remember how long that took but I believe it was 90 days for the committee and months for the review.  In the mean time Mayo was waiting to be paid.  I had to make monthly payments until UHC finally came through and I could get a refund.  The bills for this treatment were extensive and included a hospital stay.  Some of the Mayo bills were paid in full by Medicare such as the hospital stay.  Others Medicare only pays 80% then these bills were sent to UHC for their payment and we were left with a small amount to pay under this supplement.  I asked UHC for a list of what they should pay for each code billed but they never would give me that.  This is kinda of a complicated deal and Mayo's complicated billing practices made it worse.  Mayo would only have Medicare send payments that Medicare paid in full to them.  All of the Medicare payments that required additional funds from insurance were sent to us.  Mayo filled out the form for UHC and those funds were also sent to us.  We then had to pay these funds to Mayo.  Needless to say there were large sums of money going through our bank account.  Trying to keep all of this straight was crazy and nearly impossible but when the money required from us became excessive I started looking for problems.  I also needed surgery during this time and went to Mayo.  We found more UHC under payments for that.  So all of this was going on for both of us at the same time.  These UHC plans paid most of our bills and in the past when we only had minor bills and I would just pay what was billed.  I have to wonder if those bills were accurate?

The Medicare Advantage that we have now only requires a small $10 copay when seeing specialists all other medical bills are paid in full.  We have not had any problems with UHC with this plan and when the hospital makes an error and sends us a bill UHC has stepped in when requested to solve the problem.

Thanks for the info and clarification.  

My confusion stems from terminology.  That is the terms "supplement" versus "advantage".  That was the source of my question.  I think that your former employer had (has) a sort of customized plan, similar to an advantage plan, with Medicare instead of a "supplement".   

Medicare supplements (also called "Medigap" on Medicare's website) are well defined plans with letters such as  F, G, N that pays what regular Medicare doesn't cover. 

 Not to say that your former employer didn't use the word "supplement" in describing the insurance, just that it wasn't the "Medicare Supplement" plan offered to Medicare eligible people.    

For 3 or 4 years after I turned 65, my former employer had a plan similar to what you describe, that also included prescriptions.   They stopped that plan and set up a type of Health Savings Plan, (maybe it is called FSA for Federal Savings Plan?) that the company funds up to X number of dollars each year for us to select the Medicare plan that suites us.  We decide if we want a Medicare Advantage plan from whatever insurance company or a Medicare Supplement.  We also need to select Medicare prescription Plan D if we want it.  

Edited December 17, 2020 by Al F

[Barbaraok]

We are on a similar plan as retirees by our former employer.    When trying to compare to what someone else has, it is important to find our whether it's provided by a former employer as part of the retirement package and whether or not they self-fund their programs. 

[Kirk W]

1 hour ago, Barbaraok said:

When trying to compare to what someone else has, it is important to find our whether it's provided by a former employer as part of the retirement package and whether or not they self-fund their programs. 

My former employer (3M Co.) has self funded health care and so also was the retiree health plan but as a result of the ACA they changed for Medicare eligible retirees now receive an HRA each year to buy a supplement with. 

[DanZemke]

My former employer (IBM), also stopped providing me with access to their self-funded heath care plan, and switched to a HRA (in effect, a  $3K a year checking account for medical expenses - use it or lose it).  But I think the motivation was cost cutting.  The change happened 2 years before there was an ACA.

[NamMedevac 70]

In addition to full VA health care including full dental and eye care I have an AARP Medicare Supplemental plan F that unlike Medicare advantage plan provides me full medical care coverage in the the several different states I frequently travel and camp at.  I have used this several times over the years with great success so with both VA and Medicare I am fully covered for most everything possible where ever I am at.  

Retired Accountant & SEC CFP and former Pilot to Two Texas Governors.

https://www.facebook.com/media/set/?set=a.1739912699644241&type=3

https://www.facebook.com/Capt-Bill-Perkins-Evergreen-Helicopters-Singapore-HeliServices-Internat-1602761913330016

 

[Dutch_12078]

3 hours ago, NamMedevac 70 said:

In addition to full VA health care including full dental and eye care I have an AARP Medicare Supplemental plan F that unlike Medicare advantage plan provides me full medical care coverage in the the several different states I frequently travel and camp at.  I have used this several times over the years with great success so with both VA and Medicare I am fully covered for most everything possible where ever I am at.  

Retired Accountant & SEC CFP and former Pilot to Two Texas Governors.

https://www.facebook.com/media/set/?set=a.1739912699644241&type=3

https://www.facebook.com/Capt-Bill-Perkins-Evergreen-Helicopters-Singapore-HeliServices-Internat-1602761913330016

 

Our UHC Medicare Advantage Plan gives us coverage everywhere we travel at in-plan co-pays. We've never had a problem finding in-plan providers anywhere we've needed medical services. Out of plan providers can also be used at higher co-pays, but we've never needed that.

[Randyretired]

Not all Medicare Advantage Plans are the same.  Some plans are pretty basic but some provide very good coverage everywhere. Our employer provided Medicare Advantage Plan has a $10 copay for specialists but covers everything else 100% anywhere Medicare is accepted.